A 24-month postsurgical follow-up evaluation was performed on 49 patients (20 males and 29 females; meam age 26 years [range 9 to 52 years]) who had undergone orthognathic surgery in which coralline porous block hydroxyapatite (PBHA) was used as a bone graft substitute. Followup ranged from 23 to 45 months (average 27 months). One surgeon implanted all 215 block: 189 blocks to the maxilla, 19 blocks to the mandible, and seven blocks to the midfacial region. Of the 215 implants, 135 were positioned directly adjacent to the maxillary sinus. Nine patients had postsurgical complications: three developed sinusitis, which was treated with antibiotics and decongestants, four had midpalatal implants exposed intraorally during surgery that later required removal, one had a slight displacement of a mandibular implant that has remained in place, and one had an interdental implant exposed that was recontoured and covered with tissue. At the 24-month followup or later, only one of the 49 patients had complications or symptoms associated with the PBHA grafts. She was treated by removal of a midpalatal graft 37 months postsurgery. These results strongly support the use of coralline PBHA along with bone plate fixation to provide predictable stability in orthoganthic surgery.